Thoughts on the new Drug Strategy 2017 – Part 3 Building Recovery

The Government published its new Drug Strategy on 14th July. It sets out “how the government and its partners, at local, national and international levels, will take new action to tackle drug misuse and the harms it causes.”

With his years of experience in this field here is the third in a series of reflective pieces from Will Johnston.

Building Recovery

To anyone with prior knowledge of drug and alcohol commissioning and treatment, it’s hard to know where to start with the Building Recovery section of the new strategy without thinking “been there, done that”.

Raise “ambition for recovery by enhancing treatment quality and improving outcomes through tailored interventions for different user groups”? Tick.

“Deliver an enhanced joined-up approach to commissioning and delivery of the wide range of services, in addition to treatment, that are essential to supporting every individual to live a life free from drugs and dependence”? Tick.

Collaborate with partners to ensure end to end support for service users? Tick Inform local commissioning and contracting by utilising “service user involvement and clinical expertise”? Tick

It’s almost as if the strategies authors looked at the treatment systems that have been developed over the last 15 years and thought “how can we make it look like we’re affecting change without really doing anything?”. The answer it turns out is quite simple. State that we must have things that already exist, but then make it virtually impossible to keep them maintained, so that when they disappear the finger can be pointed and local authorities can be scalded for not taking on board the messages of the strategy.

With clever use of verbal gymnastics, the strategy affirms that the grant which funds treatment and prevention services for drugs and alcohol will continue to be ring-fenced until April 2019. So that’s alright then. Except . . . that although the Public Health Grant (PHG) is indeed ring-fenced, specific drugs and alcohol funding within the PHG isn’t. Ring-fencing for that has been removed.

The next sentence is the real buck-passer; “During this period we will maintain the condition for local authorities to have regard to the need to improve the take up of, and outcomes from, drug and alcohol services”. The intention post-2019 is that local authorities fund addiction services from retaining business rates and without the help of the PHG. So if it fails, it’s their fault, not the central government genius’ who thought, naively or otherwise, that the priorities, good practices and good results of the previous 15 years, would magically be retained when the money tap was switched off.

The fantasy continues when commissioning practice is highlighted.

Drug (and alcohol) treatment in the community is commissioned by local authorities which are ideally placed to coordinate drug treatment services with broader services provided, including the housing and homelessness sector, children’s services, and social care.

This doesn’t really take two tier authorities into consideration. Coordinating housing services for people in drug treatment is considerably more problematic when you have no housing stock, or financial leverage with an external organisation. Even when the broader services are within the same authority, the strategies authors are assuming the same desire across all departments, something that is commonly lacking.

Treatment services also need to improve collaboration with mental and physical health care; employment services provided by Jobcentre Plus and contracted provision, including the new Work and Health Programme; the criminal justice system, and notably providing care “through the gate” to those patients leaving prison; and all relevant community services and groups e.g. domestic abuse services.

In my experience this has always been the goal. The issue, for example, in the case of mental health services, has been the pushback received from those services who don’t consider it to be their problem.

Jobcentre Plus buy-in has always been sketchy, but was helped enormously by the dedicated regional positions responsible for increasing the engagement of people with substance misuse issues. That is, until they were discontinued. Work Programme providers receive elements of Payment By Results (PBR) and as such people with complex needs, such as people with long-standing substance misuse issues, are not particularly attractive to them.

The jury in respect of the quality of ‘Through the Gate’ provision remains out. Some may be fit for purpose, but others, such as those who class the drive from prison gate to hostel as an intervention, or who hit their homelessness PBR by providing accommodation on the first night following release but nothing after that, may need further consideration.

A recurring theme from this section is the role of the commissioner:

“Commissioners should support and develop quality governance”, “commissioners seek these assurances”, “Commissioners should also assure themselves that all substance misuse services are appropriately registered”, “commissioners should refer to service user and local provider/clinician feedback”, “commissioners need to be sure that the services they commission have a workforce which is competent”.

As a former commissioner, I wholeheartedly agree. However, I can’t help but wonder why the assumption is being made in this strategy that such important, but let’s face it, basic, aspects of a commissioner’s job need to be highlighted. Is the Government conceding to the realisation that the experienced commissioners who built the “world-leading drug and alcohol treatment system” over the past 10-15 years have left for pastures new (and not always at their own volition), driven out by cuts and restructures that diluted their portfolio and undermined by academically well qualified but inept and inexperienced Public Health staff who now need to learn the job from scratch. It’s a good job no lives are at stake.